| NPI | 1073535357 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111NR0200X Chiropractor Radiology (Licence: CA RHC147634) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: CA DC26387) |
| Enumeration Date | 2006-07-24 |
| Last Update Date | 2007-07-31 |